492 - The Association Between Adverse Childhood Experiences and Care Coordination

Poster Number: 492
Publication Number: 492.100

Meaghan L. Nazareth, Campbell University, Cary, NC, United States; Karina Javalkar, Boston Children's Hospital, Boston, MA, United States; Maria Ferris, UNC at Chapel HIll, Chapel HIll, NC, United States

Background: Adverse childhood experiences (ACEs) have been linked to negative health outcomes in adulthood, increased no-show appointments, reduced scheduled healthcare utilization, and greater emergency services use. The association between Adverse Childhood Experiences (ACEs) and care coordination has not been sufficiently explored.

Objective: To examine the association between ACEs & care coordination among US adolescents.

Design/Methods: ACEs included caregiver divorce/separation, death, or jail time; witnessing/experiencing domestic violence in the home/neighborhood; living with anyone with severe mental illness or who uses substances; or being treated/judged unfairly due to their race/ethnicity. We analyzed demographics, individual/cumulative ACEs, and care coordination in adolescents ages 12-17 years-old from the National Survey of Children’s Health from 2018-2019. An adjusted model included child age, sex, race/ethnicity, and insurance status.
 

Results: We included 13,301 adolescents whose caregivers reported needing care coordination. The weighted sample size was 12,321,658.  Weighted adolescent’s characteristics included: mean age of 14.5 (SD 1.7), 50.5% males, 53.3% White non-Hispanic, 9.4% Other/Multi-racial non-Hispanic, 24.0% Hispanic, 13.3% Black non-Hispanic and 95.1% had insurance. In this sample, 51.7% experienced ACEs (23.6% experienced one and 28.1% two or more) and 67.7% received care coordination. Those with an increasing number of ACEs reported reduced effective care coordination.
Nine individual ACEs were associated with a significantly lower odds of receiving care coordination. The lowest odds were among those who witnessed/were victims of neighborhood violence, witnessed domestic violence, lived with anyone who was mentally ill/suicidal/severely depressed, or lived in households where it was often hard to cover food/housing.
Cumulative ACEs (grouped as 0, 1, or 2+ ACEs) were associated with lower odds of receiving care coordination in unadjusted (OR = 0.724, 95% CI = 0.7223 0.725) and adjusted models (OR = 0.723, 95% CI = 0.722, 0.724). In the adjusted model, females (OR = 0.920, 95% CI 0.918, 0.922) and Hispanic (OR = 0.782, 95%CI = 0.779, 0.784) also had significantly reduced odds of receiving care coordination services.
 Conclusion(s): In this sample, we found that adolescents who had experienced ACEs of any type had an increased odds of receiving inadequate or ineffective care coordination. Increased efforts to coordinate care among adolescents who have experienced early life trauma may be a promising method to increase quality of care and ultimately reduce later adult health effects. 
Nazareth CVMeaghan Nazareth 1.5.22 CV - PAS.pdf
Cumulative ACEs and Care Coordination Received (Figure 1)